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    Questions about treatment
    Jano53 posted:
    My brother had surgery for Prostate Cancer in 2009, with complete removal. They found cancer in two lymp nodes. He was placed on hormone therapy, with no other treatment. His PSA has starrted to rise again, and after a bone scan his doctor has decided he would benefit from radiation treatments for 7 weeks. My question is this: Why use the radiation treatment if you cannot determine if it has moved to another location? Is it because they know that area stands a greater chance of having the cancer return? Also, I understand a PET scan is usually not done on Prostate Cancer patients. Any suggestions?
    Basir U Tareen, MD responded:
    1. You are correct, that PET CT is not very sensitive for prostate cancer.

    2. Unfortunately, when PSA rises after definitive surgery it is always a challenge to determine if it is from local recurrence or distant mets. In general, local recurrence has a slower PSA rise. However, with the use of hormones, the PSA rise is harder to interpret.

    3. I don't know of any data which says radiation is of any benefit in lymph node positive disease.

    4. Adjuvant radiation (given after prostatectgomy) is most effective in locally advanced disease (positive margins, extracapsular extension, etc.), but once the disease is in the lymph nodes it becomes very difficult for a radiation oncologist to treat that disease even if they radiate both sides of the pelvic lymph nodes.

    Its hard for me to say much more without knowing the entire history, but it sounds like you are asking the right questions and I'm sure your urologist and radiation oncologist can continue to guide your care.

    Best of luck,
    Jano53 replied to Basir U Tareen, MD's response:
    Thank you so very much for your expert input. I have asked many more questions, and you have given me some great guidlines to follow!

    I appreciate the time you have taken to respond to my inquiry!

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    For more information, visit the Duke Health Prostate Cancer Center